THIOPENTAL SODIUM

Intravenous anaesthetic. Very short-acting barbiturate; does not have analgesic properties

Dosage Forms

▼

Powder for injection

500 mg

Uses

▼
  • Induction of general anaesthesia
  • Anaesthesia of short duration
  • Status epilepticus
  • Reduction of raised intracranial pressure in controlled ventilation

Dose and Duration

▼
Induction of anaesthesia

Adult: by slow IV injection using a 25 mg/ml solution, initially 100–150 mg over 10–15 seconds followed by another dose if required according to response after 30–60 seconds or up to 4 mg/kg (max 500 mg).

Elderly and debilitated: reduce dose.

Child 1–18 years: by slow IV injection, initially, up to 4 mg/kg, then 1 mg/kg repeated as necessary (max total dose 7 mg/kg).

Neonate: by slow IV injection, initially up to 2 mg/kg, then 1 mg/kg repeated as necessary (max total dose 4mg/kg).

Raised intracranial pressure

Adult: 1.5–3 mg/kg repeated as required.

Status epilepticus

Adult: by slow IV injection of a 25 mg/ml solution, 75–125 mg as a single dose.

Child 1 month–18 years: initially 4 mg/kg by slow IV injection, then up to 8 mg/kg/hour by continuous IV infusion, adjusted according to response.

Neonate: initially 2 mg/kg by slow IV injection, then up to 8 mg/kg/hour by continuous IV infusion, adjusted according to response.

Preparation

▼
  • For IV injection, dilute powder to a concentration of 25 mg/ml. Dilute 500 mg with 20 ml of water for injections.
  • For IV infusion, dilute to a concentration of 2.5 mg/ml with normal saline solution.

Contra-indications

▼
  • Acute porphyria
  • Myotonic dystrophy
  • Inability to maintain airway
  • Hypersensitivity to barbiturates
  • Dyspnoea or obstructive respiratory disease

Side Effects

▼
  • Hypotension and hiccup with rapid injection
  • Arrhythmias, myocardial depression
  • Laryngeal spasm
  • Cough, sneezing
  • Headache
  • Hypersensitivity reactions, rash
  • Injection-site reactions

Interactions

▼
  • Chlorpromazine, fluphenazine, haloperidol (enhanced hypotensive effect)
  • Verapamil (enhanced hypotensive effect and AV delay)

Patient Instructions

▼
  • Do not perform skilled tasks such as driving for at least 24 hours after administration.
  • Do not take alcohol within 24 hours of administration.

Pregnancy

▼
  • Can be used.

Breast-feeding

▼
  • Can be used.

Storage

▼
  • Store powder below 25°C.
  • Store reconstituted solution between 2−8°C and use it within 7 hours.

⚠️ Caution

▼
  • Sedative effects can last up to 24 hours although awakening is rapid.
  • Reconstituted solution is very alkaline and extravasation causes severe pain and tissue necrosis.
  • Avoid intra-arterial injection because it causes intense pain and may result into arteriospasm.
  • Use with caution in cardiovascular disease, hypovolemia, severe haemorrhage, burns, status epilepticus, myasthenia gravis, adrenocortical insufficiency, cachexia and raised blood urea nitrogen.
  • Use with caution and reduce dose in hepatic impairment.
  • Use with caution in severe renal impairment.
  • Thiopental may depress neonatal respiration when used during delivery. Do not exceed 250 mg in pregnancy.
  • Large or repeated doses severely depress respiration and delay recovery.